Complications in minimally invasive percutaneous fixation of thoracic and lumbar spine fractures and tumors

Abstract

Purpose We propose to evaluate the complication rate in minimally invasive stabilization (MIS) for spine fractures and tumors, as a common alternative to open fusion and conservative treatment. Methods From 2000 to 2010, 187 patients were treated by minimally invasive percutaneous fixation in 133 traumatic fractures and 54 primitive and/or secondary spine tumors. Complications were classified, according to the period of onset as intraoperative and postoperative, and according to the severity, as major and minor. Results A total of 15 complications (8 %) were recorded: 5 intraoperative (3 %), 6 early postoperative (3 %) and 4 late postoperative (2 %); 6 were minor complications (3 %) and 9 were major complications (5 %). Conclusions Minimally invasive stabilization of selected spine pathologies appears to be a safe technique with low complication rate and high patient satisfaction. MIS reduces hospitalization and allows a fast functional recovery improving the quality of life.

Outcomes of percutaneous pedicle screw fixation for spinal trauma and tumours

“…Compared to the few available studies (Table 3), our results are consistent [11][12][13][14][15][16][17][18][19]. The largest study by Gasbarrani et al, conducted over a 10 year period from 2000-2010 in a mixed cohort of trauma and metastatic disease patients, reported 15 complications out of the 187 patients included in the report [19].…”

“…Thoracic vertebrae are also at a slightly elevated risk of blood loss than the lumbar vertebrae due to the increased abundance of neurovascular bundles within close proximity [8]. Therefore, easier visualisation and fixation is possible in the lumbar region, accounting for the lower operation time and blood loss reported by Gasbarrani et al [19] In the only animal study, conducted by Lehmann et al, favourable outcomes were demonstrated using percutaneous pedicle screw fixation [17]. The authors performed bilateral pedicle screw fixations on 12 mature sheep at the L4-L6 level.…”

The Role of Minimally Invasive Techniques in the Treatment of Thoracolumbar Trauma

“…Complications after PPSI have also been a topic of study within the literature, with a reported incidence in up to 12% of cases (15,17,18,(20)(21)(22)(23) (15). In this cohort, medical and neurologic complications included 1 case of cauda equina syndrome requiring urgent surgical revision, 1 case of wound infection with dehiscence that required surgical debridement with implant removal, and 1 case of nonunion which required anterior thoracoscopic fusion.…”

“…Percutaneous pedicle screw fixation (PPSI) has been utilized to provide immediate stabilization and adequate reduction in cases of thoracolumbar trauma (15)(16)(17)(18)(19)(20)(21)(22)(23)(24). PPSI without anterior reconstruction or augmentation is primarily utilized in AO type A1 (wedge-compression) and A2 (split) fractures without posterior vertebral wall involvement or significant vertebral body comminution (25).…”

“…In regards to medical and neurologic complications, isolated incidences of complications such as wound infection and cauda equina syndrome have been described in the literature. Gasbarrini et al reported 1 case of cauda equina syndrome, 1 case of wound infection, and 1 case of non-union in a cohort of 101 patients treated with PPSI for thoracolumbar fractures(17).…”